tailieunhanh - Sarcoidosis of the Upper Lung Fields Simulating Pulmonary Tuberculosis

This prospective observational study was undertaken at the Chest Clinic in Talera Hospital located in the Pimpri Chinchwad area of Pune. This clinic serves as the District TB Centre (DTC) for the Pimpri Chinchwad Municipal Corporation (PCMC) area under the Revised National Tuberculosis Control Programme of India. The DTC at Talera Hospital has a good record of implementation of the RNTCP and is located in an area with a high prevalence of HIV infection. Between 11 to 31 per cent of the new TB patients attending the Talera Clinic had concurrent HIV infection, similar to that reported earlier from other. | Sarcoidosis of the Upper Lung Fields Simulating Pulmonary Tuberculosis Alvin s. Teirstein . . and Louis E. Siltzbach . . Fifty-four of 616 patients 9 percent with sarcoidosis exhibited upper lung field radiographic abnormalities which mimicked adult tuberculosis. Difficulty in diagnosis occurred when patients presented with residual upper zonal shadows which had persisted after clearing of lower and midzonal densities. The abnormalities of sarcoidosis appeared as streaks and nodules simulating acinonodose tuberculosis. Contraction of the upper zones with retraction of the mediastinal structures may be just as prominent as in fibrotic tuberculosis. Bullae can sometimes be mistaken for tuberculous cavities and small multiple radiolucencies may be mistaken for tuberculous bronchiectasis. Awareness that upper zonal sarcoidosis represents a residual manifestation of the more usual pattern of hilar adenopathy and diffuse lower and midzonal infiltrations aids in distinguishing this radiographic pattern from that of adult tuberculosis. Obtaining a radiograph dating back to an earlier stage can be crucial in making this differentiation. When confronted with upper lung field abnormalities the diagnosis of sarcoidosis as wen as tuberculosis should come to mind and appropriate clinical support should be sought r 11 he radiographic patterns of pulmonary sarcoidosis when localized to the upper lung zones may closely mimic the typical appearance of pulmonary tuberculosis often leading to confusion in diagnosis. Symmetrical bilateral hilar and right paratracheal lymphadenopathy is recognized as the hallmark of early intrathoracic sarcoidosis stage I .1 Later in approximately one half of the patients pulmonary mottling appears and may assume either a micro-nodular reticular or confluent patchy configuration stage 2 . These radiographic shadows may be diffusely distributed or they may be localized. Finally in the third stage the enlarged mediastinal lymph nodes .